Provider Demographics
NPI:1992731798
Name:GONZALEZ, EDUARDO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JOSE
Last Name:GONZALEZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3625 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3509
Mailing Address - Country:US
Mailing Address - Phone:310-763-1336
Mailing Address - Fax:310-763-1350
Practice Address - Street 1:3625 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3509
Practice Address - Country:US
Practice Address - Phone:310-763-1336
Practice Address - Fax:310-763-1350
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA73502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH61960Medicare UPIN